Skip to main content
SpringerLink
Log in

Management of Severe Traumatic Brain Injury: A Practical Approach

  • Chapter
  • First Online:
Neurological Emergencies

  • 1512 Accesses

Abstract

Severe traumatic brain injury (TBI) is an entity that has maintained its prevalence, about to be considered the “silent epidemic” of this new millennium. Its epidemiological profile is changing. It is a heterogeneous entity, dynamic and changing over time. Its physiopathology is complex with profound impact at systemic level. Critical care is a key link in the chain of care. The advancement of multimodal neuromonitoring (MMM) techniques has made a remarkable contribution. The current therapy of severe TBI should follow the multidisciplinary precept, based on a deep scientific reasoning supported by pathophysiological knowledge. The bases of the same should be based in the following premises: to limit the primary damage and to avoid secondary and tertiary injuries through achieving the physiological homeostasis of the organism, to maintain adequate cerebral perfusion pressure (CPP), to avoid ischemia and cerebral hypoxia, and at the same time that elevations of intracranial pressure (ICP) are controlled and cerebral metabolism is maintained according to the energetic needs that the injury infringes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rubiano AM, Carney N, Chesnut R, Puyana JC. Global neurotrauma research challenges and opportunities. Nature. 2015;527:S193–7.

    Article  CAS  Google Scholar 

  2. Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9:231–6.

    Article  Google Scholar 

  3. Stochetti N, Carbonara M, Citerio G, Ercole A, Skrifvars MB, Smielewski P, et al. Severe traumatic brain Injury: targeted management in the intensive care unit. Lancet Neurol. 2017;16:452–64.

    Article  Google Scholar 

  4. Chesnut RM. A conceptual approach to managing severe traumatic brain injury in a time of uncertainly. Ann N Y Acad Sci. 2015;1345:99–107.

    Article  Google Scholar 

  5. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(Suppl 1):S1–106.

    Google Scholar 

  6. Carney N, Totten AM, OʼReilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery. 2017;80:6–15.

    PubMed  Google Scholar 

  7. Gennarelli TA. Mechanisms of brain injury. J Emerg Med. 1993;11(Suppl 1):5–11.

    PubMed  Google Scholar 

  8. Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34:216.

    Article  CAS  Google Scholar 

  9. Godoy DA, Videtta W, Di Napoli M. Practical approach to posttraumatic intracranial hypertension according to pathophysiologic reasoning. Neurol Clin. 2017;35:613–40.

    Article  Google Scholar 

  10. ATLS. Advanced trauma life support. 8th ed. Chicago, USA: American College of Surgeons; 2008.

    Google Scholar 

  11. Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014;13:844–54.

    Article  Google Scholar 

  12. Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: The FOUR score. Ann Neurol. 2005;58:585–93.

    Article  Google Scholar 

  13. Bouzat P, Sala N, Payen J-F, Oddo M. Beyond intracranial pressure: optimization of cerebral blood flow, oxygen, and substrate delivery after traumatic brain injury. Ann Intensive Care. 2013;3:23.

    Article  Google Scholar 

  14. Marshall LF, Marshall SB, Klauber MR, van Berkum Clark M. A new classification of head injury based on computerized tomography. J Neurosurg. 1991;75(Suppl):S14–20.

    Article  Google Scholar 

  15. Godoy DA, Lubillo S, Rabinstein AA. Pathophysiology and management of intracranial hypertension and tissular brain hypoxia after severe traumatic brain injury: an integrative approach. Neurosurg Clin N Am. 2018;29:195–212.

    Article  Google Scholar 

  16. Godoy DA, Behrouz R, Di Napoli M. Glucose control in acute brain Injury: does it matter? Curr Opin Crit Care. 2016;22:120–7.

    PubMed  Google Scholar 

  17. Menon DK, Ercole A. Critical care management of traumatic brain injury. Handb Clin Neurol. 2017;140:239–74.

    Article  CAS  Google Scholar 

  18. Godoy DA, Murillo-Cabezas F, Egea-Guerrero JJ, Carmona-Suazo JA, Muñoz-Sánchez MA. Diagrams to interpret and solve physiopathological events triggered after severe traumatic brain injury. Med Intensiva. 2015;39:445–7.

    Article  CAS  Google Scholar 

  19. Godoy DA, Seifi A, Garza D, Lubillo-Montenegro S, Murillo-Cabezas F. Hyperventilation therapy for control of posttraumatic intracranial hypertension. Front Neurol. 2017;8:250.eCollection 2017.

    Google Scholar 

  20. Oddo M, Poole D, Helbok R, Meyfroidt G, Stocchetti N, Bouzat P, Cecconi M, Geeraerts T, Martin-Loeches I, Quintard H, Taccone FS, Geocadin RG, Hemphill C, Ichai C, Menon D, Payen JF, Perner A, Smith M, Suarez J, Videtta W, Zanier ER, Citerio G. Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations. Intensive Care Med. 2018;44:449–63.

    Article  Google Scholar 

  21. Madden LK, Hill M, May TL, Human T, Guanci MM, Jacobi J, Moreda MV, Badjatia N. The implementation of targeted temperature management: an evidence-based guideline from the Neurocritical Care Society. Neurocrit Care. 2017;27:468–87.

    Article  Google Scholar 

  22. Lelubre C, Taccone F. Transfusion strategies in patients with traumatic brain injury: which is the optimal hemoglobin target? Minerva Anestesiol. 2016;82(1):112–6.

    PubMed  Google Scholar 

  23. Vedantam A, Robertson C, Gopinath S, et al. Progressive hemorrhagic injury after severe traumatic brain injury: effect of hemoglobin transfusion thresholds. J Neurosurg. 2016;125: 1229–34.

    Article  CAS  Google Scholar 

  24. Robertson CS, Hannay HJ, Yamal JM, Gopinath S, Goodman JC, Tilley BC, Investigators ESTBIT. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA. 2014;312:36–47.

    Article  Google Scholar 

  25. Napolitano LM, Kurek S, Luchette FA, Anderson GL, Bard MR, Bromberg W, Chiu WC, Cipolle MD, Clancy KD, Diebel L, Hoff WS, Hughes KM, Munshi I, Nayduch D, Sandhu R, Yelon JA, Corwin HL, Barie PS, Tisherman SA, Hebert PC, EAST Practice Management Workgroup; American College of Critical Care Medicine (ACCM) Taskforce of the Society of Critical Care Medicine (SCCM). Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. J Trauma. 2009;67:1439–42.

    Article  Google Scholar 

  26. Mangat HS, Wu X, Gerber LM, Schwarz JT, Fakhar M, Murthy SB, et al. Hypertonic saline is superior to mannitol for the combined effect on intracranial pressure and cerebral perfusion pressure burdens in patients with severe traumatic brain injury. Neurosurgery. 2019. pii: nyz046.

    Google Scholar 

  27. Andrews PJ, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, Murray GD, Eurotherm3235 Trial Collaborators. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med. 2015;373:2403–12.

    Article  CAS  Google Scholar 

  28. Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, et al. Brain Oxygen Optimization in Severe Traumatic Brain injury (BOOST) phase II: a phase II randomized trial. Crit Care Med. 2017;45:1907–14.

    Article  Google Scholar 

  29. Hughes JD, Rabinstein AA. Early diagnosis of paroxysmal sympathetic hyperactivity in the ICU. Neurocrit Care. 2014;20:454–9.

    Article  CAS  Google Scholar 

  30. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of traumatic brain injury author group. Neurosurgery. 2006;58(3 Suppl):S1–S75.

    Google Scholar 

  31. Adams H, Kolias AG, Hutchinson PJ. The role of surgical intervention in traumatic brain injury. Neurosurg Clin N Am. 2016;27:519–28.

    Article  Google Scholar 

  32. Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502.

    Article  CAS  Google Scholar 

  33. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375:1119–30.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Critical Care, Hospital San Juan Bautista, Sanatorio Pasteur, Catamarca, Catamarca, Argentina

    Daniel Agustin Godoy

  2. Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Catamarca, Argentina

    Daniel Agustin Godoy

  3. Intensive Care Unit, Hospital San Juan Bautista, Catamarca, Catamarca, Argentina

    Daniel Agustin Godoy

  4. Departments of Clinical Research and Neurotrauma, Meditech Foundation/Barrow Neurological Institute at PCH/University of Cambridge, Cali, Valle del Cauca, Colombia

    Ahsan Ali Khan

  5. Department of Clinical Research/Neurosciences Institute, El Bosque University/Meditech Foundation, Bogotá, Cundinamarca, Colombia

    Andres M. Rubiano

Authors
  1. Daniel Agustin Godoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahsan Ali Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andres M. Rubiano
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Mayo Clinic, Neuroscience ICU, Rochester, MN, USA

    Alejandro A. Rabinstein

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Godoy, D.A., Khan, A.A., Rubiano, A.M. (2020). Management of Severe Traumatic Brain Injury: A Practical Approach. In: Rabinstein, A. (eds) Neurological Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-030-28072-7_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-28072-7_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28071-0

  • Online ISBN: 978-3-030-28072-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation